Organization
363L00000X
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANETHA DEBORAH PETERSON (NURSE PRACTITIONER)
(678) 464-9424
Entity
Organization
Contact information
Practice address
2171 PEACHTREE RD NE, APT 306, ATLANTA, GA 30309-6300
(678) 464-9424
Mailing address
2171 PEACHTREE RD NE, APT 306, ATLANTA, GA 30309-6300
(678) 464-9424
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
363L00000X
GA
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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